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The global climate has been changing over the last century due to greenhouse gas emissions and will continue to change over this century, accelerating without effective global efforts to reduce emissions. Ticks and tick-borne diseases (TTBDs) are inherently climate-sensitive due to the sensitivity of tick lifecycles to climate. Key direct climate and weather sensitivities include survival of individual ticks, and the duration of development and host-seeking activity of ticks. These sensitivities mean that in some regions a warming climate may increase tick survival, shorten life-cycles and lengthen the duration of tick activity seasons. Indirect effects of climate change on host communities may, with changes in tick abundance, facilitate enhanced transmission of tick-borne pathogens. High temperatures, and extreme weather events (heat, cold, and flooding) are anticipated with climate change, and these may reduce tick survival and pathogen transmission in some locations. Studies of the possible effects of climate change on TTBDs to date generally project poleward range expansion of geographical ranges (with possible contraction of ranges away from the increasingly hot tropics), upslope elevational range spread in mountainous regions, and increased abundance of ticks in many current endemic regions. However, relatively few studies, using long-term (multi-decade) observations, provide evidence of recent range changes of tick populations that could be attributed to recent climate change. Further integrated ‘One Health’ observational and modeling studies are needed to detect changes in TTBD occurrence, attribute them to climate change, and to develop predictive models of public- and animal-health needs to plan for TTBD emergence.

Mosquitoborne disease outbreaks occur every year in the United States from one or more of the arboviral diseases dengue, West Nile, LaCrosse, Eastern equine encephalitis, and Zika (1). Public opinion communicated through traditional and social media and the Internet, competing public health and resource priorities, and local conditions can impede the ability of vector control organizations to prevent and respond to outbreaks of mosquitoborne disease. The Environmental Protection Agency (EPA) and CDC performed a coordinated review of the concerns and challenges associated with continuation of mosquito surveillance and control during public health emergencies and disasters. This report highlights the first joint recommendation from EPA and CDC. Mosquito surveillance and control should be maintained by state and local mosquito control organizations to the extent that local conditions and resources will allow during public health emergencies and natural disasters. Integrated pest management (IPM) is the best approach for mosquito control (2). IPM uses a combination of methods, including both physical and chemical means of control (3). For chemical means of control, CDC and EPA recommend the use of larvicides and adulticides following the EPA label. It is imperative that public health recommendations be followed to ensure the safety of the pesticide applicator and the public.

Haemaphysalis longicornis is a tick indigenous to eastern Asia and an important vector of human and animal disease agents, resulting in such outcomes as human hemorrhagic fever and reduction of production in dairy cattle by 25%. H. longicornis was discovered on a sheep in New Jersey in August 2017 (1). This was the first detection in the United States outside of quarantine. In the spring of 2018, the tick was again detected at the index site, and later, in other counties in New Jersey, in seven other states in the eastern United States, and in Arkansas. The hosts included six species of domestic animals, six species of wildlife, and humans. To forestall adverse consequences in humans, pets, livestock, and wildlife, several critical actions are indicated, including expanded surveillance to determine the evolving distribution of H. longicornis, detection of pathogens that H. longicornis currently harbors, determination of the capacity of H. longicornis to serve as a vector for a range of potential pathogens, and evaluation of effective agents and methods for the control of H. longicornis. Published version

Plague is a highly virulent fleaborne zoonosis that occurs throughout many parts of the world; most suspected human cases are reported from resource-poor settings in sub-Saharan Africa. During 2008–2016, a combination of active surveillance and laboratory testing in the plague-endemic West Nile region of Uganda yielded 255 suspected human plague cases; approximately one third were laboratory confirmed by bacterial culture or serology. Although the mortality rate was 7% among suspected cases, it was 26% among persons with laboratory-confirmed plague. Reports of an unusual number of dead rats in a patient’s village around the time of illness onset was significantly associated with laboratory confirmation of plague. This descriptive summary of human plague in Uganda highlights the episodic nature of the disease, as well as the potential that, even in endemic areas, illnesses of other etiologies might be being mistaken for plague.

CDC has updated the interim guidance for U.S. health care providers caring for pregnant women with possible Zika virus exposure in response to 1) declining prevalence of Zika virus disease in the World Health Organization's Region of the Americas (Americas) and 2) emerging evidence indicating prolonged detection of Zika virus immunoglobulin M (IgM) antibodies. Zika virus cases were first reported in the Americas during 2015-2016; however, the incidence of Zika virus disease has since declined. As the prevalence of Zika virus disease declines, the likelihood of false-positive test results increases. In addition, emerging epidemiologic and laboratory data indicate that, as is the case with other flaviviruses, Zika virus IgM antibodies can persist beyond 12 weeks after infection. Therefore, IgM test results cannot always reliably distinguish between an infection that occurred during the current pregnancy and one that occurred before the current pregnancy, particularly for women with possible Zika virus exposure before the current pregnancy. These limitations should be considered when counseling pregnant women about the risks and benefits of testing for Zika virus infection during pregnancy. This updated guidance emphasizes a shared decision-making model for testing and screening pregnant women, one in which patients and providers work together to make decisions about testing and care plans based on patient preferences and values, clinical judgment, and a balanced assessment of risks and expected outcomes.

The introduction of Zika virus into the Region of the Americas (Americas) and the subsequent increase in cases of congenital microcephaly resulted in activation of CDC's Emergency Operations Center on January 22, 2016, to ensure a coordinated response and timely dissemination of information, and led the World Health Organization to declare a Public Health Emergency of International Concern on February 1, 2016. During the past year, public health agencies and researchers worldwide have collaborated to protect pregnant women, inform clinicians and the public, and advance knowledge about Zika virus (Figure 1). This report summarizes 10 important contributions toward addressing the threat posed by Zika virus in 2016. To protect pregnant women and their fetuses and infants from the effects of Zika virus infection during pregnancy, public health activities must focus on preventing mosquito-borne transmission through vector control and personal protective practices, preventing sexual transmission by advising abstention from sex or consistent and correct use of condoms, and preventing unintended pregnancies by reducing barriers to access to highly effective reversible contraception.

Climate change is anticipated to alter the production, use, release, and fate of environmental chemicals, likely leading to increased uncertainty in exposure and human health risk predictions. Exposure science provides a key connection between changes in climate and associated health outcomes. The theme of the 2015 Annual Meeting of the International Society of Exposure Science-Exposures in an Evolving Environment-brought this issue to the fore. By directing attention to questions that may affect society in profound ways, exposure scientists have an opportunity to conduct "consequential science"-doing science that matters, using our tools for the greater good and to answer key policy questions, and identifying causes leading to implementation of solutions. Understanding the implications of changing exposures on public health may be one of the most consequential areas of study in which exposure scientists could currently be engaged. In this paper, we use a series of case studies to identify exposure data gaps and research paths that will enable us to capture the information necessary for understanding climate change-related human exposures and consequent health impacts. We hope that paper will focus attention on under-developed areas of exposure science that will likely have broad implications for public health.

Tularemia is a tick-borne zoonotic bacterial disease. In the United States, human tularemia infections are caused by Francisella tularensis subspecies tularensis (Type A, clades A1 and A2) or F. tularensis subspecies holarctica (Type B). We developed a mouse model that can be used to study the ability of ticks to acquire and transmit fully virulent strains of F. tularensis (A1, A2, and Type B). We showed that 1) bacteremia was evident by 2 days post-infection (dpi) for A1, A2, and B, 2) bacteremia was expected to reach levels of > 10 8 cfu/mL by 3 dpi for A1 and A2 but not until 4 dpi for Type B, and 3) illness onset was delayed for mice exposed to Type B compared with A1 and A2. To maximize the likeli- hood of ticks acquiring infection from laboratory-infected mice before they become moribund and must be euthanized, ticks should be placed on mice so that periods of rapid engorgement occur 3-4 dpi for A1 and A2 and 4-5 dpi for Type B. Rigorous experimental studies of tick vector competence and efficiency conducted under standardized conditions are required to address several significant public health issues related to preventing and controlling tularemia. Our study pro- vides the basis for a mouse model needed as the starting point to address these questions.

Ecologic niche modeling has allowed numerous advances in understanding the geographic ecology of species, including distributional predictions, distributional change and invasion, and assessment of ecologic differences. We used this tool to characterize ecologic differentiation of Triatoma brasiliensis populations, the most important Chagas' disease vector in northeastern Brazil. The species' ecologic niche was modeled based on data from the Fundação Nacional de Saúde of Brazil (1997-1999) with the Genetic Algorithm for Rule-Set Prediction (GARP). This method involves a machine-learning approach to detecting associations between occurrence points and ecologic characteristics of regions. Four independent "ecologic niche models" were developed and used to test for ecologic differences among T. brasiliensis populations. These models confirmed four ecologically distinct and differentiated populations, and allowed characterization of dimensions of niche differentiation. Patterns of ecologic similarity matched patterns of molecular differentiation, suggesting that T. brasiliensis is a complex of distinct populations at various points in the process of speciation.

Ecologic niche modeling may improve our understanding of epidemiologically relevant vector and parasitereservoir distributions. We used this tool to identify host relationships of Triatoma species implicated in transmission of Chagas disease. Associations have been documented between the protracta complex (Triatoma: Triatominae: Reduviidae) with packrat species (Neotoma spp.), providing an excellent case study for the broader challenge of developing hypotheses of association. Species pairs that were identified coincided exactly with those in previous studies, suggesting that local interactions between Triatoma and Neotoma species and subspecies have implications at a geographic level. Nothing is known about sylvatic associates of T. barberi, which are considered the primary Chagas vector in Mexico; its geographic distribution coincided closely with that of N. mexicana, suggesting interaction. The presence of this species was confirmed in two regions where it had been predicted but not previously collected. This approach may help in identifying Chagas disease risk areas, planning vector-control strategies, and exploring parasite-reservoir associations for other emerging diseases. hagas disease is caused by the parasitic protozoan Trypanosoma cruzi and transmitted by blood-feeding insects in the family Reduviidae, subfamily Triatominae. Chagas disease is an important cause of illness and death throughout the Americas, affecting 16–18 million persons. While an estimated 100 million persons in 21 countries in the New World live in endemic areas and are at risk for infection, the disease is principally a zoonotic infection, in which sylvatic mammals serve as reservoir hosts and zoophilic triatomine species as vectors. The protracta species group consists of seven species (Triatoma protracta, T. peninsularis, T. sinaloensis, T. neotomae, T. barberi, T. nitida, and T. incrassata); T. protracta contains five subspecies: T. p. protracta, T. p. woodi, T. p. navajoensis, T. p. zacatecensis, and T. p. nahuatlae (1,2). This group is restricted to the southwestern United States and Mexico. Previous studies have demonstrated high host specificity in this species group, involving woodrats or packrats (Neotoma spp.) (1). Whereas host associations of Triatoma are often complex, the protracta group shows remarkable host specificity and geographic distributions suggestive of host-ectoparasite cospeciation. A new tool in the study of geographic phenomena in ecology and systematics is ecologic niche modeling of primary occurrence data (data placing a particular species in a particular site) (3). In general, the approach involves a machine-learning algorithm for discovering associations between pointoccurrence data and sets of electronic maps summarizing environmental/ecologic dimensions that may or may not be important in limiting species’ geographic distributions. These associations constitute an approximation of species’ fundamental ecologic niches (the conjunction of ecologic conditions in which a species is able to maintain populations without immigration) (4) and hence provide a basis for understanding numerous ecologic and geographic phenomena related to species distributions. We applied ecologic niche modeling to identify host relationships of Triatoma species and subspecies implicated in the transmission of Chagas disease. Previous studies by Ryckman (1) provide an ideal test case: hypotheses of association developed based on the modeling approach can be tested independently by using associations identified in Ryckman’s detailed field studies. If successful, this approach would be invaluable in identifying host relationships for species for which detailed information is not available, for stratifying Chagas disease risk areas, and for planning the operational aspects of vector control strategies. Methods

▪ Abstract Chagas disease is caused by the parasitic protozoan Trypanosoma cruzi and transmitted by insects in the family Reduviidae, subfamily Triatominae, commonly known as kissing bugs. Because these insects feed throughout their entire developmental cycle on vertebrate blood, they harbor populations of symbiotic bacteria in their intestinal track that produce nutrients that are lacking in the insects' limited diet. It is possible to cultivate these bacteria, genetically modify them, and place them back into their insect host, thus generating a paratransgenic insect. This procedure has allowed the expression of antitrypanosomal gene products in the insect gut, thereby resulting in insects that are incapable of transmitting Chagas disease. A method has been developed that would allow introduction and spread of genetically modified symbionts into natural populations of kissing bugs, thus leading potentially to a transgenic intervention tool for use as a part of an integrated vector control approach.

As part of a fatal human plague case investigation, we showed that the plague bacterium, Yersinia pestis, can survive for at least 24 days in contaminated soil under natural conditions. These results have implications for defining plague foci, persistence, transmission, and bioremediation after a natural or intentional exposure to Y. pestis.

Guest Editors: Nina Marano (Figure 1), Paul Arguin (Figure 2), Marguerite Pappaioanou (Figure 3), and Jay C. Butler (Figure 4). Figure 1 Guest editor Nina Marano. Dr Marano is the chief of the Geographic Medicine and Health Promotion Branch in the Division of Global Migration and Quarantine at CDC. The branch mission is to protect the health of US travelers at home and abroad and to prevent ... Figure 2 Guest editor Paul Arguin. Dr Arguin is the chief of the Domestic Response Unit in the Malaria Branch within the National Center for Zoonotic, Vectorborne, and Enteric Diseases at CDC. Figure 3 Guest editor Marguerite Pappaioanou. Dr Pappaioanou is professor of infectious disease epidemiology in the School of Public Health with a joint appointment in the College of Veterinary Medicine at the University of Minnesota. Her areas of interest are ... Figure 4 Guest editor Jay C. Butler. Dr Butler is on detail from CDC to the Alaska Division of Public Health, where he is deputy director for science and medicine and is the state epidemiologist. His research interests include vaccine-preventable diseases, antimicrobial ... Snakes on a Plane was poised to be the blockbuster movie of the 2006 summer season. It featured reptiles smuggled onto an airplane as an unusual bioweapon of mass destruction. In a much less dramatic fashion, this absurd scenario plays out every day, when tons of live animals and unprocessed animal products are shipped internationally around the globe, providing many opportunities for rapidly translocating zoonotic pathogens. Episodes of emerging zoonoses are being increasingly recognized around the world. From 1996 to 2004, some 21% of 10,490 reports of animal diseases from 191 countries submitted to the Program for Monitoring Emerging Diseases (ProMED) concerned humans affected by zoonotic disease (1). This zoonoses theme issue of Emerging Infectious Diseases (EID) corroborates this finding, presenting reports of zoonotic disease from all corners of the globe, including the People's Republic of China, Vietnam, Slovakia, Indonesia, the United States, Israel, Bangladesh, the Netherlands, Brazil, Algeria, India, the Democratic Republic of the Congo, and Italy. As public health and animal health organizations attempt to respond to these emerging and reemerging zoonotic diseases, their ability and skill in forming new strategic partnerships are of paramount importance. This year was highlighted by the establishment of the Centers for Disease Control and Prevention (CDC) as a World Organization for Animal Health (OIE) Collaborating Center for Emerging and Remerging Zoonoses. To initiate this collaborating center, the International Symposium on Emerging Zoonoses (ISEZ) was held in conjunction with the International Conference on Emerging Infectious Diseases and the International Conference on Women and Infectious Diseases in Atlanta in March 2006. ISEZ was cosponsored by OIE, the United Nations Food and Agriculture Organization, the US Department of Agriculture Animal and Plant Health Inspection Service, the Department of Interior US Geological Survey, National Wildlife Health Center, the World Health Organization, and CDC. ISEZ was attended by >400 veterinarians, physicians, and public health professionals from all over the world. The objective of the symposium was to share information among public health and animal health professionals so that more effective and cooperative partnerships could be developed. In turn, this would help to better understand, prevent, and control new microbial dangers to human and animal health that occur globally every day. The 44 internationally renowned ISEZ speakers and moderators recognized the spirit in which this meeting was created. Their participation reflected a true commitment to the partnership between public health and animal health needed to meet the ever-growing microbial challenges threatening human, animal, and environmental health on a seemingly continual basis. The speakers lent their talent and expertise to the following themes: the epidemiology of pathogens and diseases shared among humans and animals, the risks of wildlife and exotic pet trade to human and animal health, the effects of agricultural practices on human and ecosystem health, the lessons learned from previous experiences, and collaborative achievements. Speakers offered solutions that had been tested through innovative, interdisciplinary, and intersectoral research to deal with the problems of emerging zoonoses. A few presentations are highlighted below. In his presentation, Emerging and Remerging Zoonoses from Wildlife Reservoirs to Exotic Pets, Bruno Chomel, University of California, Davis, College of Veterinary Medicine, reminded participants that most emerging infectious diseases are zoonotic, with wildlife constituting a large and often unknown reservoir. Wildlife can also be a source for reemergence of previously eradicated zoonoses. The discovery of such zoonoses is often related to better diagnostic tools. However, human modification to natural wildlife habitats and human behavior, such as deforestation, which causes range expansion of the tick vector for Kyasanur Forest disease in India, also create opportunities for emergence of zoonotic diseases. Translocation of raccoon dogs from Asia into Europe has provided a new potential rabies reservoir. Human behavior includes sleeping with pets, reported by 30% of Americans, and keeping of exotic pets that provide opportunities for microbial transmission that have not existed until recently. More than 10,000 pet tigers are kept in the United States—more tigers than are currently living in the wild throughout the world. Thus, addressing human influences on ecosystems and behavior with regard to wild and exotic animals must be incorporated into efforts at preventing and controlling emerging diseases that involve wildlife and other valued natural resources. In her presentation, Combined Vaccination Delivery to Remote and Mobile Pastoral Families and Their Animals, Esther Schelling, Swiss Tropical Institute, focused on the potential of joining public health and veterinary services to achieve higher vaccination coverage in Africa's remote rural settings. Such sharing is aimed at reducing vaccine-preventable diseases in persons and their livestock. Her findings from Chad indicated that sharing transport logistics and cold chain equipment between the public health and veterinary sectors in the most remote areas reduced total program delivery costs, was highly valued by pastoralists, and was an important strategy to connect hard-to-reach populations with needed vaccinations such as for measles and polio for children and anthrax for livestock. By optimizing the use of limited logistic and human resources, public health and veterinary services were strengthened, especially at the district level, and, in turn, the services can become more prepared to respond to endemic and epidemic diseases. ISEZ participants learned about the impact of human behavior on emergence and subsequent spread of highly pathogenic avian influenza (HPAI) H5N1 strain in Asia from Vincent Martin of the Food and Agriculture Organization. Human behavior that supported disease emergence includes agriculture practices that allow species mixing, limited biosecurity to prevent mixing of domestic and wild animals, and a cultural preference for warm meat that has made live bird markets common in urban areas. These factors act synergistically with the intrinsic characteristics of the virus and the rapid evolution of animal and farming production systems in the region to support emergence. Martin emphasized that understanding the underlying farming practices and cultural preferences that influenced the emergence and spread of HPAI in developing countries has been instrumental in implementing effective risk reduction measures. The experience of fighting HPAI in Asia shows that control efforts should be focused on production sectors with low biosecurity standards and free-ranging chickens and ducks. Creating conditions that are not conducive to microbial selection and emergence represents a major challenge, from a disease management and cultural point of view, for reducing the risk for avian influenza occurrence and subsequent human infection. This issue of EID continues in the tradition of the 2 previous December theme issues by focusing on zoonoses, reminding readers again that we must maintain a vigilance in combatting these microbial threats. The issue highlights efforts directed at identifying disease reservoirs and finding better ways to understand, evaluate, prevent, and control disease transmission. At the same time, healthy ecosystems need to be promoted, economic livelihoods safeguarded, and cultural beliefs respected at household to national and international levels. Contained in this issue are articles based on the following ISEZ presentations: Review of Bats and SARS (2) and Ecologic Niche Modeling and Spatial Patterns of Disease Transmission (3). Also featured are articles that focus on the role of risk factors for introducing zoonotic diseases, such as monkeypox associated with domestic trade in certain animal species and human behavior as a risk factor for exposure to avian influenza in Vietnam. Many species of animals are highlighted, including cats colonized with methicillin-resistant Staphylococcus aureus, horses and wild mammals infected with West Nile virus, dogs with rickettsial infections, turkeys with human metapneumovirus, and nonhuman primates infected with malaria. We encourage our readers to continue to conduct and submit the findings of essential research on emerging zoonotic diseases to EID as we strive to share and disseminate this information to our multidisciplinary readership.

Tularemia is a tick-borne zoonotic bacterial disease. In the United States, human tularemia infections are caused by Francisella tularensis subspecies tularensis (Type A, clades A1 and A2) or F. tularensis subspecies holarctica (Type B). We developed a mouse model that can be used to study the ability of ticks to acquire and transmit fully virulent strains of F. tularensis (A1, A2, and Type B). We showed that 1) bacteremia was evident by 2 days post-infection (dpi) for A1, A2, and B, 2) bacteremia was expected to reach levels of10(8) cfu/mL by 3 dpi for A1 and A2 but not until 4 dpi for Type B, and 3) illness onset was delayed for mice exposed to Type B compared with A1 and A2. To maximize the likelihood of ticks acquiring infection from laboratory-infected mice before they become moribund and must be euthanized, ticks should be placed on mice so that periods of rapid engorgement occur 3-4 dpi for A1 and A2 and 4-5 dpi for Type B. Rigorous experimental studies of tick vector competence and efficiency conducted under standardized conditions are required to address several significant public health issues related to preventing and controlling tularemia. Our study provides the basis for a mouse model needed as the starting point to address these questions.

In July 2007, a deer fly–associated outbreak of tularemia occurred in Utah. Human infections were caused by 2 clades (A1 and A2) of Francisella tularensis subsp. tularensis. Lagomorph carcasses from the area yielded evidence of infection with A1 and A2, as well as F. tularensis subsp. holarctica. These findings indicate that multiple subspecies and clades can cause disease in a localized outbreak of tularemia.

Triatoma dimidiata, one of the major vectors of Chagas disease in Central America, is found in both domestic and peri-domestic habitats. Questions concerning population boundaries, infestation rates, insecticide resistance, and geographic dispersal of triatomine bugs persist and may be resolved using genetic markers such as microsatellites. Microsatellites are short tandem repeats found dispersed throughout a genome and can be useful for genotypic identification. We developed a plasmid library from the genomic DNA isolated from a single T. dimidiata adult collected in Guatamala. Ten thousand clones were screened using a probe consisting of nine microsatellite oligonucleotides. Eight loci appear polymorphic among populations found in Guatemala, Honduras, and Mexico, and thus are potentially useful for population genetic applications.

Although Pneumocystis carinii pneumonia is one of the leading causes of morbidity and mortality among patients with the acquired immunodeficiency syndrome, many questions about its epidemiology and transmission remain unanswered. Whereas traditional theory postulates that the disease results from reactivation of latent infection, recent data suggest that active acquisition of infection, either through environmental exposure or person-to-person transmission, may occur. This review summarizes the current state of knowledge about the epidemiology and transmission of P. carinii and reports on evolving techniques that may improve our understanding of this organism in the future.

At a recent workshop, experts discussed the benefits, risks, and research priorities associated with using genetically manipulated insects in the control of vector-borne diseases.

Infections with vector-borne pathogens are a major source of emerging diseases. The ability of vectors to bridge spatial and ecologic gaps between animals and humans increases opportunities for emergence. Small adaptations of a pathogen to a vector can have profound effects on the rate of transmission to humans.

Many haematophagous insects harbour bacterial symbionts, involved either in nutritional mutualism or as reproductive system parasites. Recent studies have demonstrated the feasibility of genetically transforming these agents in an effort to express foreign genes in their host that could potentially alter the host’s ability to transmit a disease pathogen (Beard et al., 1993b; Richards, 1993). As the insect-symbiont relationships of other vectors, both of human and plant pathogenic agents, are further explored, it is likely that this approach will find a broad application.

Field research with vectors is an essential aspect of vector biology research and vector-borne disease prevention and control. This type of research, which brings experimental vector manipulations into endemic areas, can present risks to human populations. This paper seeks to stimulate a full discussion within the medical entomology community of the risks associated with vector field research. Such discussions will promote development of a consensus, among investigators, sponsoring agencies and the communities within which the work is done, so that appropriate steps can be taken to minimize and manage the risks, and adequate oversight can be maintained.

Forgotten People, Forgotten Diseases is an interesting and highly informative book about the global status of neglected tropical diseases (NTDs). Author Peter Hotez introduces NTDs by describing them in general, their historical importance and global impact, and their shared characteristics. According to Hotez, NTDs are among the most common infections from antiquity and occur in the world’s poorest people. Their distribution and health and economic effects are similar to those of AIDS, malaria, and tuberculosis. NTDs, however, are much less well known than these diseases and frequently display high rates of illness but few deaths, promote poverty, and create profound social stigma. Twelve well-illustrated chapters address the important NTDs, including soil-transmitted helminth infections, schistosomiasis, filariasis, onchocerciasis, trachoma, mycobacterial infections, trypanosomiasis, leishmaniasis, dengue, leptospirosis, and rabies. Hotez discusses what these diseases are, where they occur, and who they affect. The final chapters focus on prospects to prevent and control NTDs and the need for additional advocacy. Hotez emphasizes the need for new safer and more effective drugs, as well as for so-called “anti-poverty vaccines,” which by promoting health will open doors to economic advancement and stability, goals that have been all but impossible in developing countries, largely because of NTDs. Few people are more qualified to write such a book than Hotez, president of the Sabin Vaccine Institute and a pioneer in hookworm molecular genetics, physiology, immunology, and pathogenesis. This easy-to-read and up-to-date text undoubtedly will prove useful to graduate students, volunteers, advocates, healthcare professionals, and others interested in global health and equality. Forgotten People, Forgotten Diseases is an essential read for every serious student of tropical medicine and global infectious diseases.